The World Health Organization (WHO) estimates that the number of people living with hypertension (blood pressure (BP) of ≥ 140 mmHg systolic or ≥ 90 mmHg diastolic or on medication) doubled between 1990 and 2019, from 650 million to 1.28 billion. Elevated BP is associated with increased risks of stroke, coronary artery disease (CAD), heart failure (HF), and chronic kidney disease (CKD). Resistant hypertension (RH) is defined as office BP ≥ 140/90 mmHg despite treatment with three classes of antihypertensive agents (including a diuretic) at maximally tolerated doses, or the need for four or more agents regardless of BP level. Device-based antihypertensive therapies primarily target autonomic nervous system through techniques, such as renal denervation, carotid baroreceptor activation, and carotid body ablation. This review outlines the pathophysiological basis of selected interventions, critically evaluates existing clinical evidence, and highlights future directions for their development and integration into clinical practice.

Hypertensive heart disease is a major cause of heart failure (HF), this study evaluate the global burden and trends of HF attributable to hypertensive heart disease from 1990 to 2021.

Over one-third of Canadians with hypertension do not achieve recommended blood pressure (BP) targets despite availability of effective treatments. Renal sympathetic nerve denervation (RDN) is a recently approved, minimally invasive treatment for hypertension being offered in multiple Canadian centers. How best to implement this procedure in contemporary Canadian clinical practice remains unclear. Herein, we provide a Canadian hypertension specialist viewpoint on use of RDN in Canada. We review the rationale for, and evidence supporting, the use of RDN and discuss, using two clinical cases, its potential therapeutic role. We note that RDN has effectively lowered BP in multiple, sham-controlled, randomized clinical trials and has a favourable safety profile. Economic modeling estimates that it is cost-effective in the Canadian context. Conversely, the BP lowering effect is relatively modest; no well-established method to pre-identify responders exists; cardiovascular endpoint data supporting use of RDN are lacking; and no clear funding model is currently in place in Canada. Accordingly, we suggest that use of RDN be reserved for willing patients with severely elevated BP despite the use of first-line conventional therapies who have had secondary causes excluded. Examples include patients with resistant hypertension or moderate or severe hypertension and multiple drug intolerance syndrome. In view of its recent approval and known operator-dependency, RDN should be offered solely through programmatic, multidisciplinary collaboration between hypertension specialists and experienced interventionalists using a shared decision-making approach with the patient. Funding deployment should target such programs and sites should carefully monitor their outcomes to confirm comparability to the published literature.

Diagnosing hypertension typically requires repeated blood pressure (BP) readings taken over multiple days, but obtaining accurate BP measurements from patients at home is known to be challenging, at least in part due to failure to accurately report those measurements. Here, we evaluate two low-cost electronic reporting strategies, text messaging and a novel image-based alternative, for acceptability and accuracy.

Self-measured blood pressure monitoring (SMBP) is a proposed strategy to improve hypertension control, but few studies compare SMBP with automated office blood pressure (AOBP) measurements over time. Moreover, little is known about reimbursement for these services.

Multivitamin-multimineral (MVM) supplements have been associated with lower blood pressure (BP) in several small trials. We investigated the effects of a MVM on incident hypertension and BP in a secondary analysis of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS).

Vascular aging, often defined in terms of arterial stiffness and impaired arterial hemodynamics, is an important factor associated with hypertension and CVD. Aortic stiffness, a more particular measure of arterial stiffness focusing on central hemodynamics (ie, the aorta), is an independent predictor of hypertension and CVD risk. Higher levels of physical activity are associated with lower arterial stiffness in various White populations, for peripheral and central measures of stiffness, but further investigations into Black populations are warranted. We examined the association between physical activity and aortic stiffness among participants in the Jackson Heart Study (JHS).

The rate of hypertension hospitalizations is increasing among US adults. Individuals with low socioeconomic position are more likely to have high blood pressure (BP), which may increase their risk of hypertension hospitalization and adverse post-discharge outcomes.

The Hiroshima Registry for Evaluation and Treatment of Nocturnal and Early Morning Hypertension (Hiroshima NOCTURNE) was a prospective, multicenter study designed to determine whether elevated nighttime blood pressure (BP), assessed using a home BP monitoring (HBPM) device, can be normalized through active antihypertensive therapy in patients already receiving antihypertensive medication. In this subanalysis, we aimed to identify factors associated with failure to normalize nocturnal hypertension.

Recent studies show that cardiovascular disease (CVD) risk increases from a lower nadir of systolic blood pressure (SBP) in women than men, and increases thereafter at a greater rate. This has led to a suggestion that sex-based SBP thresholds are required. We investigated sex differences in the associations of SBP and incident atherosclerotic CVD.

This study investigates the causal associations between specific plasma lipids, immune cells, and aortic dissection (AD) pathogenesis, and explores immune cells as mediators in this relationship.

Thoracic aortic dissection (TAD) is a potentially fatal condition. It has been linked with hypertension, and guidelines recommend antihypertensives.

Out-of-office blood pressure (BP) monitoring is a critical component of modern hypertension diagnosis and management. Measuring BP outside of clinic reduces the stress response that contributes to white coat hypertension and also allows for the identification of masked hypertension, yielding more accurate cardiovascular disease (CVD) risk assessment and improved CVD prevention. Home BP monitoring and 24-hour ambulatory BP monitoring outperform office BP in predicting CVD outcomes and are cost-effective aspects to cardiovascular health promotion by preventing unnecessary treatment, reducing clinic visits, and lowering event-related costs. Despite these advantages, routine implementation remains limited due to patient, provider, and system-level barriers, including validated device access, workflow integration, patient-provider communication tools, and adherence. Efforts to minimize or eliminate these barriers are crucial to CVD prevention. Evidence is also needed to support alternative out-of-office BP measurement strategies, including community-based strategies, such as BP assessment by school nurses, pharmacists, or community health workers. The utility of these modalities in diagnosing and managing children with hypertension are greatly needed as the long-term prognostic data in this population are sparse. Expanding adoption and evidence for out-of-office monitoring is essential to optimize hypertension care and CVD risk reduction.

Blood pressure (BP) present a diurnal pattern with a nocturnal decrease and an increase in early morning. Evidence suggests that an exaggerated morning BP surge is associated with higher cardiovascular risk. This is the first study evaluating the association between dialysis timing and morning BP surge in hemodialysis.

Hypertension prevalence remains high among U.S. young adults, and the role of social needs in their hypertension management remains poorly understood.

It is not well established whether blood pressure variability (BPV) is associated with risk of incident heart failure (HF) as well as with subclinical markers of HF and myocardial injury.We investigated these relationships in the Multi-Ethnic Study of Atherosclerosis (MESA).